HomeMy WebLinkAbout12-31-08 (2)REV-1500 15056041158
EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box Zsosoi INHERITANCE TAX RETURN 21 08 1050
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
10092008 10141916
Decedent's Last Name Suffix Decedent's First Name M I
FAILOR DEAN H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
FILL IN APPROPRIATE BOXES BELOW
1. Original Return
^ 4 Li
i
d E
. m
te
state
6. Decedent Died Testate
(Attach Copy of Will)
^
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Return
^
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
^
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5 F
d
l E
T
R
R
i
. e
era
state
ax
eturn
equ
red
~ 8. Total Number of Safe Deposit Boxes
^
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
STANLEY A• SMITH, ESQUIRE 717-233-5731
Firm Name (If Applicable)
RHOADS ~ SINON LLP
First line of address
PO BOX ],146
Second line of address
City or Post Office State
HARRISBURG PA
Correspondent'se-mail address: SSMITHa~RHOADS-SINON • COM
ZIP Code L-
17108-1146
J- -,
S`J ~
Lz~
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of prepan:r other than the personal representative is based on all information of which prepan:r has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
PLEASE SEE ATTACHED
ADDRESS
C/0 RHO & SIN N LLP PO BOX 1146 HARRISBURG PA 1'71D8-],146
SIGNATURE O R H AN R P E ATIVE DATE
~ ~ ,STANLEY A • SMITH, ESQUIRE I7- 7~ D~~
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041158
6M4647 3.000
REGISTER OF WILLS USE QN}Y
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15056041158
_J ^t
Estate of Dean H.. Failor
Executors (Page .L)
Name Donated E. Failor
Address c/o Rhoads & Sinon LLP
PO Box 1146
Harrisburg, PA 17108-1146
Tax ID - -
Name John R. Failor
Address c/o Rhoads & Sinon LLP
PO Box 1146
Harrisburg, PA 17108-1146
Tax ID - -
178-16-6961
ATTACHMENT TO FORM REV-1500
Estate of: Dean H. Failor
Date of Death: October 9, 2008
SS#: 178-16-6961
Under penalties of perjury, I declare that I have examined this return, including accompanying
schedules and statements, and to the best of my knowledge and belief, it is true, correct and
complete.
~,.~ ~. ._.-.i 9---
Donald E. Failor, Co-Executor
'~k'a.~
15056042159
REV-1500 EX
Decedent's Social Security Number
Decedent's Neme:F A I L O R DEAN H
RECAPITULATION
1. Real estate (Schedule A) 1. 0 • 00
2. Stocks and Bonds (Schedule B) . 2. 0 • 00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. 0 • 0 0
4. Mortgages & Notes Receivable (Schedule D). 4. 0 • 00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. ], 0 8 4 5 • 0 0
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested 7. 81758 • 00
8. Total Gross Assets (total Lines 1-7). 8. 9 2 6 0 3. 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 6 614 , 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 6 4 , 0 0
11. Total Deductions (total Lines 9 & 10) . 11. 6678 • 00
12. Net value of Estate (Line 8 minus Line 11) 12. 8 5 9 2 5 • 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J). 13. 0 • 00
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 8 5 9 2 5 • 0 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x .OIL 0, 0 0 15. 0.0 0
16. Amount of Line 14 taxable
at lineal ratex .oy.5 85926.00 16. 3867.00
17. Amount of Line 14 taxable
at sibling rate X .12 0 , 00 17. 0 • 00
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18• 0. 0 0
19. TAX DUE 19.
3867.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042159 snnasae2.ooo 15D56042159
REV-1508 EX + (fr98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & M~S\i.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Dean H. Failor 2108 1050
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Sovereign Bank checking account #231372691 8,482
2 1990 Buick LeSabre
Sale price at auction 1,040
3 Erie Insurance Company
Refund check 37
4 Tangible Personal Property
Valued per co-executors 750
5 Erie Insurance Company
Refund check 193
6 AAA
Refund check. 30
7 Capital Blue Cross
Refund of insurance premium 313
TOTAL (Also enter on line 5 Recapitulationj $ ~ 10, 845
3w46AD 1.000 (If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (Fi98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
Dean H. Failor 21 08 1050
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBE DESCRIPTION OF PROPERTY
irrcLwE rre wrnE oFrrE rRANSFEREE, rHEiR RELArioNSr+iP ro DECEDErrr AND
TFEDATEOFTRANSFER ATTAC:HACOW OF THE DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
IF APPLICABLE)
TAXABLE
VALUE
~~ Dean H Failor Trust under
Agreement acct #20002734006 81,758 100.0000 0 81,758
TOTAL (Also enter on line 7, Recapitulation) $
81,758
(If more space is needed, insert additional sheets of the same size)
3W46AF 1.000
REV-1511 EX+(10-06) SCHEDULE H
FUNERAL EXPENSES &
ANIA
COMMO
O
T ADMINISTRATIVE COSTS
TAX RETURN
ANCE
HER
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Dean H. Failor 21 08 1050
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
~ Malpezzi Funeral Home
Funeral expense 1,642
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 4 , 2 5 0
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
4.
5.
6.
7.
1
7W46AG 1.000
City State Zip _
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
RESERVES: Rhoads & Sinon LLP
Out of pocket expenses to include: Postage - $14.97;
Stock Evaluation - $3.10; Copies - $7.80; Reserve
for additional expenses - $74.13
Total from continuation schedules .
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
256
90
376
6.614
LAST WILL AND TESTAMENT
OF
DEAN H. FAILOR
I, DEAN H. FAILOR, of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do
make, publish and declare this to be my Last Wi:Ll and Testament,
hereby revoking all Wills and Codicils by me at any time
previously made.
I am married to Edna M. Failor (hereinafter referred to
as "My Spouse") and the children born of our ma.~riage are John R.
Failor and Donald E. Failor (hereinafter referred to as "My
Sons") .
1. TANGIBLE PERSONAL PROPERTY. I give and bequeath
all of my household furniture and furnishings, automobiles, other
motor vehicles; books, pictures, jewelry, china, crystal,
appliances, silverware, wearing apparel, articles of household or
personal use or adornment, to My Spouse, if My Spouse survives me.
If My Spouse does not survive me, I give such articles to My Sons
living at my death in as nearly equal shares as they shall select
under the supervision of my Executor. If any s1:1ch articles cannot
Page 1 of 6 Pages
431453.1
y-;:._.
be fairly divided or distributed in kind in thE, opinion of my
Executor, such articles shall be sold and-the proceeds thereof
shall pass as a part of my residuary estate.
2. RESIDUE. I give, devise and bequeath all of the
rest, residue and remainder of my property, real, personal and
mixed, not disposed of in the preceding portions of this Will, to
My Spouse, if My Spouse survives me. If My Spouse does not
survive me, I give, devise and bequeath said rE~sidue to my issue
living at my death, per stirpes.
3. SPENDTHRIFT PROVISION. No interest in income or
principal of my estate shall be subject to attachment, levy or
seizure by any creditor, spouse, assignee or trustee or receiver
in bankruptcy of any beneficiary of my estate prior to the
beneficiary's actual receipt thereof. My Executor shall pay over
the net income and the principal to the beneficiaries herein
designated, as their interests may appear, without regard to any
attempted anticipation (except as may be speci:Eically provided
herein}, pledging or assignment by any beneficiary of my estate
and without regard to any claim thereto or attempted levy,
attachment, seizure or other process against s<3id beneficiary.
Page 2 of 6 Pages
4. SURVIVAL PRESUMPTIONS. Any person who shall have
died at the same time as I or under such circurnstances that it is
difficult or impossible to determine who shall have died first,
shall be deemed to have predeceased me.
5. FIDUCIARY POWERS. In the settlE:ment of my estate,
my Executor shall possess, among others, the following powers,
exercisable without prior court approval, but i.n all cases to be
exercised for the best interests of the beneficiaries:
(a) To retain any investments I may have at my
death so long as my Executor may deem it advisable to my
estate so to do, including securities owned, issued or
underwritten by any corporate Executor or any of its
affiliates.
(b} To vary investments, when deemed desirable by
the Trustee, and to invest in every kind of property and
type of investment, including securities owned, issued
or underwritten by any corporate Trustee or any of its
affiliates, or as to which such Trustee or its affiliate
acts as investment advisor, as the Trustee shall deem
wise.
(c) In order to effect a division of the principal
of my estate or for any other purpose, including any
final distribution of my estate, my Executor is
authorized to make said divisions or distributions of
the personalty and realty partly or wholly in kind. If
such division or distribution is made in kind, said
assets shall be divided or distributed at their
respective values on the date or dates of their division
or distribution. In making any division or distribution
in kind, my Executor shall divide or distribute said
assets in a manner which will fairly allocate any
unrealized appreciation among the beneficiaries. '
Page 3 of 6 Pages
(d) To sell either at public or private sale and
upon such terms and conditions as my Executor may deem
advantageous to my estate, any or all real. or personal
estate or interest therein owned by my estate severally
or. in conjunction with other persons or acquired after
my death by my Executor, and to consummates said sale or
sales by sufficient deeds or other instruments to the
purchaser or purchasers, conveying a fee simple title,
free and clear of all trust and without obligation or
liability of the purchaser or purchasers t.o see to the
application of the purchase money or to make inquiry
into the validity of said sale or sales; also, to make,
execute, acknowledge and.. deliver any and all deeds,
assignments, options or other writings which may be
necessary or desirable in carrying out any of the powers
conferred upon my Executor in this paragraph or
elsewhere in this Will.
(e) To borrow money from any party, including my
Executor, to pay indebtedness of mine or of my estate,
expenses of administration, Death Taxes or other taxes.
(f) To pay all costs, expenses, legally
enforceable debts, funeral expenses and charges in
connection with the administration of my estate.
(g) To compromise controversies.
(h) To disclaim, in whole or in part, any and all
interests in property owned by me at the time of my
death, including those passing to me by Will, intestacy,
contract, joint ownership, operation of law or
otherwise.
6. CUSTODIAN OF ESTATES. If at any time any
individual under the age of twenty-one shall be entitled to
receive any assets free of trust by reason of my death, whether
payable hereunder, by operation of law, contract or otherwise, I
Page 4 of 6 Pages
appoint my Executor hereinafter named as Custodian for such
individual under the Pennsylvania Uniform Transfers to Minors Act.
7. TAX CLAUSE. All inheritance, estate and similar
taxes becoming due by reason of my death {"Death Taxes"), whether
such Death Taxes shall be payable by my estate or by any recipient
of any property, shall be paid by my Executor out of the property
passing under ITEM 2 of this Will as an expense and cost of
administration of my estate. My Executor shall have no duty.or
obligation to obtain reimbursement for any Death Taxes paid by my
Executor, even though paid with respect to proceeds of insurance
or other property not passing under this Will.
8. EXECUTOR APPOINTMENT. I hereby appoint My Sons,
JOHN R. FAILOR and DONALD E. FAILOR, as Co-Executors of this Will.
If for any reason either of them should fail or cease to act, the
other shall act or continue to act with all of the powers granted
to the two of them. All references in this Will to my "Executor"
shall refer to my originally named Co-Executors, or the sole
surviving Executor, as the case may be.
9. WAIVER OF BOND. My Executor shall qualify and
serve without the duty or obligation of filing any bond or other
security. ,
Page 5 of 6 Pages
IN WITNESS WHEREOF, I have set my hand and seal to this,
my Last Will and Testament, consisting of this and the preceding
five (5) pages, this ~;~IIMI~ T~ 2002.
/ (SEAL)
Dean H. Fail r
We, the undersigned, hereby certify that the foregoing
Will was signed, sealed, published and declared by the above-named
Testator as and for his Last Will and Testament, in the presence
of us, who, at his request and in his presence and in the presence
of each other, have hereunto set our hands and. seals the day and
year above written, and we certify that at the time of the
execution the eof, the said Testator was of sound and disposing
mind and mem y.
(SEAL Residin at: ~
~,. ~ ( SEAL )
Residing at.: ~(7 C~Q~}~(' ~ ~ q~_PJ
fnolc . Pro -~p25
Page 6 of 6 Pages
COMMONWEALTH OF PENNSYLVANIA
p ~p( ~~ SS:
COUNTY OF ~YlV4~`~' ~'"~
We, DEAN H. FAILOR, ~NL~ ~ ~,~ Sium~ and
JP~J~Ji~ P~I-ILIt'Kc~S' , the
K Testator and the Witnesses, respectively,
~
whose names are signed to the foregoing instrument, having been sworn,
do hereby declare to the undersigned officer that the Testator, in the
presence of the Witnesses, signed said instrument a.s his Last Will and
Testament, that he signed voluntarily, that each of the witnesses, in
the presence of the Testator and of each other, sig,~ned said Will as a
witness and that to the best of the knowledge of each witness, the
Testator was at the time of sound mind and under no constraint or undue
influence.
c
~~
Dean '1.
Wi e
W' es
Subscribed and acknowledged before me by DEAN H. FAILOR, the
Testator, and subscribed and sworn to before me by
~,j~t;'y ~, Si~11T and _~'T1~11fF~P 1'%}1LIr~dOSfCy , the witnesses,
4~- ~-
on this day of/~j ,( ,,~ ~ , 20C12 . / ,
Notary Pu~li.c J u
My Commission Expires:
2oa~~a.i
(SEAL ) Notarial Seal
Dlone R. Robinette, Notary Public
Harrisburg, Dauphin County
. Nly Commission Expires Sept. 30, 2002
Member, Ponnsylvar~ta %+~s~~iation at -Votarias
,~~~~
Revocable Trust Account
Ap lication
LETORT An A reemer~t
g
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Section 1: Appointment Of 'Name 2 (fit's[) (~ddl~~~~,iast) 4
Trustee
I/We ("Setdor") appoint LeTort Management ~
Trust Company ("Trustee") to hold, as Trustee, cer-
tain property or interests which Setdor has turned
over to Trustee, which property or interests are set
forth on Schedule attached hereto and made a part
hereof, together with such property as may from
time to time be delivered by Setdor and accepted by
Trustee to be subject to the terms of this Agreement.
Said property and the earnings thereon and apprecia-
tion therein shall constitute Settlor's Revocable Trust
Account ("Account").
Section 2: Account Owner
Information
This account is a/an:
~/ Joint Account
^ Individual Account
Name 1 (fast) (middle) (last)
Social Security No. or Tax Identification No.
;~
Date of Birth
Telephone Number
.~,.
Address
y
City State Zip
w _ ~.
Social Security No. or Tax'Identification No.
.,a _. '~ .
Date of Birth
,~t
Telephone Number
:1.. t"t: _ -
Address
City State Zip
Setdor declares that Setdor is a (please select one):
QNatural person(s)
^Foreign corporation or partnership
^Domestic corporation or partnership
Section 3: Account
Statements
Trustee shill furnish to Setdor a statement of all
transactions in the Account during the period of the
statement ("Periodic Statements"). Statements shall
be provided:
^ Monthly
Quarterly
^Semi-Annually
^Annually
The Trustee shall not be liable with respect to
the accuracy of the Periodic Statements, except with
respect to any such transaction to which Setdor shall
object, within ninety (90) days after the furnishing
of the Periodic Statement, in writing to the Trustee.
(A317015: }
13nless Trustee receives written objection to the
Periodic Statement within ninety (90) days after the
date shown on such Periodic Statement, the Periodic
Statement shall be deemed approved. Approval of
the Periodic Statement shall be final and binding on
all persons who have an interest in the Account then
or in the future.
Section 4: Distributions
During my lifetime, my trustee shall keep the
principal invested and shall distribute the net
income and the principal as follows:
A. As much -even if all - of the net income
and the principal as I may direct from time to time,
shall be paid either to me or as I may specify;
B. As much of the income and the principal of
the Account as the Trustee, in its discretion, shall
deem advisable for the comfort, care, support and
maintenance of the individual Settlor or both Settlors
of a joint account, or of any person dependent on
either of them.
C. Any remaining net income shall from time
to time be accumulated and added to the principal.
Section 5: Instructions
Except as provided in Section 6 below, Trustee
may rely on oral or written instructions received
from the Settlor which Trustee believes were genuine
and authorized.
Section 6: Joint Revocable
Trust Accounts
In the event this is a joint account (joint
account°), it shall be treated as joint tenancies with
right of survivorship, or in the case of spouses, as
tenancies by the entireties. In joint accounts Trustee
shall collect the income and shall pay the net income
to the Sectlors as joint tenants with right of survivor-
ship, or in the case of spouses, as tenants by the
entireties, or as the Setdors (acting jointly) may
direct otherwise in writing.
If this is a joint account, after the death of the
first of the Setdors to die, payments maybe made
only to the survivor, or in accordance with the sur-
vivor's written directions.
A joint account maybe terminated in whole or
in part in accordance with Section 12 hereof by the
Settlors (acting jointly), or by the survivor of the
Settlors, in either case by written notice to the
Trustee, whereupon the securities and other property
as to which said termination extends shall be deliv-
ered to the Setdors as joint tenants with right of sur-
vivorship, or in the case of spouses, as tenants by the
entireties, or as the Setdors (acting jointly) may
direct otherwise in writing, or to the survivor, or in
accordance with the survivor's written directions.
Except where the Settlors are expressly required
under this Section 6 to act jointly in writing, Trustee
may rely on oral or written instructions received
from either of the Settlors, which Trustee believes
were genuine and authorized.
The provisions of this Section 6 supersede any
other provisions of this Agreement to the contrary if
the Account is a joint account.
Section 7: Trustef:'s Powers
and Responsibilities
In addition to the powers conferred by law, the
Trustee shall have the following powers, to be exer-
cised in its absolute discretion:
A. To retain all assets received in kind as
investments, without any duty of divezsification, or
to sell the same upon such terms as it shall deem
advisable;
B. 7o invest in alt forms of property, as author-
izedunder the Pennsylvania Prudent Investor Rule,
including in one or more of the collective investment
funds maintained by the Trustee or any affiliate, or
such other assets as are acceptable to the Trustee;
C. To hold shares in any registered investment
company which may be advised by the Trustee and
from which the Trustee or any affiliate may receive
compensation as advisor;
{A317015: }
D. To exchange or lease for any period of time
any real or personal property and to give options for
sales, exchanges and leases;
E. To exercise all rights of security holders
including the right to vote personally or by general
or limited proxy, any shares of stock;
F. To register any securities in the Trustee's
name or in the name of a nominee;
G. To pay, compromise, settle or release any
claim or controversy without court approval;
H To borrow money from any source, includ-
ing the Trustee or any of its affiliates, and to pledge
any real or personal property pursuant thereto;
I. To delegate discretionary powers;
J. To make distribution in cash or in kind at
current values, in undivided interests or non-pro rata
shares, and without regard to income tax basis.
K. To hold reasonable amounts of cash unin-
vested in any bank or trust company, for such peri-
ods as my trustee deems reasonable for the efficient
administration of any trust hereunder.
Notwithstanding the foregoing, the Settlor
reserves the right to instruct the Trustee in writing to
retain certain assets, including stock of the Trustee,
ir. a custodial capacity without any liability for
reviewing the investment suitability of such desig-
nated assets and further reserves the right to vote the
stock of the Trustee or its affiliate or successors.
Section 8: Liability and
Indemnification
Trustee shall be liable only for its recklessness or
willful misconduct. Trustee shall not be liable for
any incidental, consequential or punitive damages,
regardless of their cause or whether Trustee was
aware of the possibility of these damages. Trustee
shall not be liable for acting upon any notice,
instruction or other instrument believed by it to be
genuine and delivered by an authorized individual.
Trustee shall not be liable for damages from any
event beyond its control.
Settlor shall indemnify, defend and hold Trustee
and its officers, directors, emplcryees, Trustees and
representatives harmless from and against any suit,
judgment, claim, demand, loss, liability, expense or
interest (including legal fees and expenses) ("Losses
and Expenses") arising out of or in connection with
this Agreement, excluding, however, those Losses
and Expenses which are finally determined by a
court of competent jurisdiction to have resulted
directly from Trustee's recklessness or willful mis-
conduct in the performance of its obligations as
described by this Agreement. This indemnification
shall survive the termination of this Agreement.
Trustee shall have a first priorit}~ possessory security
interest in and a right of set off ;against the assets in
the Account to the extent of any amount owed by
Settlor to Trustee under this Agreement. This para-
graph shall survive the termination of this
Agreement.
Section 9: Shareholder
Communications
In order to facilitate company/shareholder com-
munications and for other similscr purposes, Settlor
Authorizes
/ODoes not authorize
the Trustee to release Settlor's name, address, and
share position of assets held in this Account to the
companies (or their representatives) in which
Trustee is a shareholder.
Section 10: Taxpayer
Certification
Under penalty of perjury, Settlor certifies that
- is the
Settlor's correct taxpayer identification number (or
that Settlor is waiting for a number to be issued),
and that Settlor is not subject to backup withholding
because: (a) Settlor is exempt from backup withhold-
ing, or (b} Settlor has not been notified by the
Internal Revenue Service ("IRS°) that Settlor is sub-
(A317015: )
ject to backup withholding as a result of a failure to
report all interest or dividends, or (c) the IRS has
notified Settlor that Settlor is no longer subject to
backup withholding. Setdor certifies that if any
Setdor is a natural person, each Setdor who is a nat-
ural person is a U.S. person (which includes U_S. res-
ident aliens)
Section 11: Compensation
Trustee's compensation for its services shall be in
accordance with the Trustee's standard fee arrange-
ment in effect from dme to time during the period of
the Trustee's services hereunder and may be charged
to the Account.
For any special or extraordinary services,
Trustee shall be entitled to additional reasonable
compensation.
Trustee may provide services to certain invest-
ment companies (mutual funds) as authorized by
Section 7314.1 of the Probate, Estate and Fiduciaries
Code, 20 Pa. C.SA. iS7314.1, and receives compen-
sation known as 12b-1 fees or subtransfer agency
fees from the investment companies for those servic-
es. These fees are disclosed in each mutual fund
prospectus and its annual statement, which are sepa-
rately provided.
Section 12: Amendment and
Termination
The Senior expressly reserves the right at any
time and from time to time to amend this Agreement
by written notice delivered to the Trustee provided
that the duties, powers, compensation or liability of
the Trustee shall not be charged in a manner other
than termination without its written consent.
This Agreement maybe terminated in whole or
in part by either Setdor or Trustee by giving 30 days'
prior written notice to the other party. Within nine-
ty (90) days of termination, Trustee shall deliver the
assets subject to termination to Setdor or as Setdor
directs otherwise in writing.
Upon the death of an individual Setdor or the
survivor of the Settlors of a joint account, this
Agreement shall terminate and the Trustee shall
deliver the assets as follows:
^To the personal representative of such deceased
Settlor within ninety (90) days of the deceased
Settlor's death.
^To the following person or persons:
.err ~- r
w~ , ~'~ a~.._
__~ ~~ .ti~~r~- a'-
~~, ,
During any period of time after termination in
which Trustee continues to have custody of assets
subject to termination, Trustee shall have no duties
other than the safekeeping of such assets and deliv-
ery of such assets upon Settlor's instruction. Trustee
shall have [he right to continue to charge fees in the
amount then currently charged ito the Account for
atrypnst-termination period in which assets subject
to termination remain in Trustee's custody and to
debit such fees from the Account.
Section 13: Trustees
Trustee may execute any of its powers under this
Agreement and perform the duties required of the
Trustee by and through attorneys, sub-custodians,
Trustees, affiliates or subsidiaries. The Trustee shall
noc be responsible for the perfotznance or supervi-
sion of or liable for the default or negligence of any
such person selected by Trustee with reasonable care
or of any broker or Trustee engaged in the purchase,
sale or exchange of any asset.
Section 14: Choice of Law
The Agreement and the Account hereby created
shall be construed and governed by the laws of
Pennsylvania without regard to its conflicts of law
provisions.
{A317015:}
Section 15:
Acknowledgement
By signing this Revocable Trust Account
Application and Agreement, Settlor agrees to the
terms and conditions of the Agreement.
Trustee:
LeTon Man t ~ Trust Company
By:
Signature a Title
Date: ~~ ~~-V~
.~._.,. ~t;;.
~:
Account No.: ~;,~ ~ _ ' ,..,
Settlor:
Individual Settlor Date
~ t~ ~ PB--
~,^
Joint Settlor Date
7'' o z.
Name of corporation, partnership, Date
estate, trust or other fiduciary entity
By:
Signature and Title
(A317015: }
Trust Account
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tp,317015:1
Estate Valuation
Date of Death: 10/05/2008
Valuation Date: 10/09/2008
Processing Date: 12/1;/2008
Shares Security
or Par Description High/Ask Low/Bid
1) 34014.73 Cash (CASH)
2) 2517.254 PIMCO FDS PAC INVT MGMT SER (693390304)
LOW DURATION
Mutual Fund (as quoted by NASDAQ)
10/09/2008
3) 2334.267 VANGUARD FIXED INCOME SECS FD (922031794)
GNMA ADM
Mutual Fund (as quoted by NASDAQ)
10/09/2008
Total Value:
Total Accrual:
Total: $81,757.85
34,014.73
9.48000 Mkt
9.480000 23,863.57
10.23000 Mkt
10.230000 23,879.55
]'state of: Estate of Dean H Failor
Report Type: Date of Death
Number of Securities: 3
File ID: Failor, Dean H
Mean and/or Div and Int Security
Adjus=ments Accruals Value
$0.00
$81,757.85
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
p ~ ~ ; ~, ~. ~*v ~AnA~%
Inventory for; 312 Asbury Drive - DEAN H. FAILOR
3 - Lazy Boy Rocking Chairs -'15.00
1 - T.V. Entertain tent Center - SO.0~
1 - Swivel Chair -2,5.00
1 - Double Bed with Box Springs and Mattress-floo.oo ~
1 - 3-seat Glider - 2 Chairs - End Table - Glass Top <:offee Table - ~~•oo
( Iron Stone Furniture Set )
2 - Folding Chairs --F2.5 00
2 - Floor Lamps ~SZ5.oo
1 - Table Lamp - 5•~
4 - T. V. Trays-~5•ab
4 - Outdoor - Patio Chairs 5.00
2 -Foot Stools -~`ia•Oo
1 - Ironing Board-'`3.00
2 - Clock Radios -Flo-mod
1 - Card Table -fZ•oo
1 n,~Metal ~~.Cabinet ~ X15.00
1 - Step Ladder -~5. co
1 - Garden Hose -~ 1. o0
1 - Rake - ~1. oo ,~
1 - Wooden T.V. Stand - 1• oo •~
1 - Large Framed Art Piece -- 5.00
1 - Electric Hair Clippers X2.00
1 - Set of Corning Ware Dishes - 15.00
10 -Mugs - YI o . oo y!
1 - Electric Tea Kettle - Z.oo
1 - Glass Cookie Jar - y1.00
1 - Set of .Silverware ~ 5 .co ~
1 - Set of Everyday Dishes - 16.00
1 - Coffee Maker -rtS.oo ~(
1 - Pair Men's Gol f. Shoes - S. o0
1 -Metal Stand - Z•oo 4[
2 - Hunter Ceiling Fans - (00.00
1 - Vanity Rack - lo.oo •~
2 - 4-tier Plast~c Storage Shelves - S.oa
1 - Step Stool - 3• ~o
Planting Pits . S. oo
Baskets -- Io • 0O r
Blanketsd/Sheets- 15.a O
Misc... r1~j•oO
~~~a~ . ~~150.
Donald E. Failor, xecutor
l-
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Estate of: Dean H. Failor
Schedule H Part 7 (Page 2)
2 Cumberland Law Journal
Legal advertising
3 Patriot News
Legal advertising
4 Sovereign Bank
Fee for check book
5 RESERVES: Cumberland County Register of Wills
Reserve for additional probate expenses
21 08 1050
75
204
47
50
Total (Carry forward to main schedule) 376
REV-1512 EX + (12-03)
SCHEDULEI
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
Dean H. Failor 21 08 1050
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
3wasaH 2.000 (If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dean H. Failor 2108 1050
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Donald E. Failor
1784 Autumnwood Drive
Mechanicsburg, PA 17055
50~ of Residue: 42,963 Son 42,963
2 John R. Failor
100 Hilltop Road
Boiling Springs, PA 17007
50~ of Residue: 42,963 Son 42,963
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR W HICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ 0
(If more space is needed, insert additional sheets of the same size)
3 W 46AI 1 .000
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